99308

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more

Code 99308. Medicare covered 11,795,272 of these. Here is what providers billed and what Medicare allowed, state by state.

$154.13Billed, national avg
$68.90Medicare allowed
2.2xBilled vs allowed
2.2xHighest vs lowest state

Providers in Alaska billed the most for this, at $231.62. In Alabama the average was $106.88. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$231.62$80.232.9x2,568
Armed Forces Europe$184.62$64.812.8x1,355
New York$178.46$76.032.3x1,927,692
Nebraska$178.02$68.972.6x26,206
Minnesota$176.34$65.482.7x35,249
North Dakota$175.92$70.072.5x15,915
Northern Mariana Islands$175.58$70.482.5x629
Vermont$175.00$64.762.7x5,466
Nevada$172.77$64.752.7x169,055
Delaware$172.30$65.822.6x29,735
Wyoming$171.84$70.852.4x9,069
Georgia$170.11$64.102.7x205,046
Oregon$166.15$65.092.6x12,772
Washington$162.99$67.492.4x51,347
New Jersey$161.37$73.792.2x789,149
Foreign Country$157.68$78.832.0x87
Wisconsin$157.07$63.092.5x58,848
Florida$156.24$68.172.3x1,377,635
District of Columbia$156.04$74.162.1x18,782
Massachusetts$155.66$67.972.3x310,834
California$153.71$73.282.1x1,196,289
Texas$152.15$64.822.3x781,871
Connecticut$151.16$69.532.2x181,868
Utah$150.74$63.202.4x25,981
Montana$150.23$73.112.1x8,072
Maryland$150.06$70.222.1x418,877
Pennsylvania$149.20$67.892.2x424,358
Kansas$148.62$62.442.4x65,838
Colorado$147.14$67.672.2x44,103
Michigan$145.56$65.662.2x286,130
North Carolina$145.36$62.872.3x217,116
Iowa$145.12$64.652.2x41,626
Illinois$145.05$67.772.1x700,881
Virginia$142.94$65.572.2x241,072
West Virginia$140.99$64.332.2x33,262
Arizona$139.00$65.072.1x115,224
Idaho$137.94$61.552.2x9,431
Tennessee$137.75$60.992.3x201,681
Armed Forces Pacific$137.49$60.332.3x289
Guam$137.10$78.731.7x123
Maine$136.55$62.832.2x15,314
Missouri$136.21$63.582.1x196,298
Arkansas$135.77$64.332.1x57,616
Kentucky$135.45$62.442.2x133,650
New Mexico$135.30$62.872.2x17,639
Oklahoma$134.81$63.462.1x146,402
Ohio$134.52$65.082.1x385,988
New Hampshire$134.01$65.532.0x36,042
Louisiana$133.75$63.012.1x149,303
Rhode Island$133.35$67.142.0x20,842
South Carolina$131.48$64.362.0x102,756
Indiana$130.85$61.522.1x259,471
Hawaii$130.63$74.321.8x13,818
South Dakota$128.03$64.782.0x13,311
Mississippi$125.48$61.122.1x81,529
Puerto Rico$113.16$71.761.6x558
Unknown$111.59$64.641.7x1,973
Alabama$106.88$61.901.7x121,217

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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